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Background: Antipsychotic use among dual-eligible nursing home residents is a concern for cost and safety considerations.

Objective: To examine the comparative risk of death in dual-eligible elderly nursing home residents using typical and atypical agents.

Methods: A retrospective cohort design matched on propensity score was used to examine the risk of death due to antipsychotic use among dual-eligible nursing home residents 65 years or older from four states. New typical and atypical users in nursing homes were followed for 6 months after the exposure without any censoring. The risk of death was modeled using the Cox proportional model and the extended Cox hazard model stratified on matched pairs based on propensity score.

Results: The unadjusted mortality rate was 18.42% for atypical antipsychotic users and 24.06% for typical antipsychotic users. The Cox proportional-hazards regression model revealed significant increased risk of death [hazard ratio (HR), 1.41; 95% confidence interval (CI), 1.27–1.57] among typical users when compared with atypical users. The extended Cox model, used due to the violation of proportional hazards assumption, revealed that risk of death was nearly twice as great among typical antipsychotic users within 40 days of antipsychotic treatment (HR, 1.81; 95% CI, 1.49–2.18) when compared with atypical users. However, moderate increase in risk (HR, 1.24; 95% CI, 1.09–1.42] was observed for 40–180 days of typical antipsychotic exposure.

Conclusions: The use of typical antipsychotic agents was associated with highest risk of all-cause mortality within 40 days of typical antipsychotic use when compared with atypical use, and the risk decreased after 40 days among dual-eligible elderly nursing home residents.

Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Texas Medical Center, Houston, TX

Supported by a grant from the Agency for Healthcare Research & Quality (AHRQ RO3HS016920-01A1).